New Study Says ER Docs Should Test All Patients for Alcohol

It has long been known that a substantial percentage of trauma victims in hospital emergency rooms present with an elevated blood alcohol level – but a new study shows that testing for alcohol in ERs, instead of just asking about drinking, helps to identify people with likely alcohol use disorders and helps to predict further medical complications.

Without alcohol, hospital emergency rooms would be much
quieter places. Alcohol plays a role in about a third of trauma admissions; it
also complicates the assessment and diagnosis process for ER doctors and
increases the likelihood of further medical complications.

In much of the world, the ER standard for alcohol assessment
is to ask the trauma victim, or an accompanying friend or family member, about
drinking behaviors prior to the trauma incident. Many American trauma centers routinely test
for blood alcohol content (BAC), but since BAC levels fall by the hour after cessation
of drinking, these may give an incomplete picture of alcohol consumption prior
to the traumatic event. Newer alcohol biomarkers can assess the level of
alcohol consumption in weeks preceding the test.

Dr. Michael Fleming, out of the University of Wisconsin,
led a research team that investigated the benefits of testing patients admitted
to hospital emergency rooms for blood alcohol levels.

The researchers tested 213 patients admitted to a university
hospital and found that 22% presented with an elevated blood alcohol level and
that 12% eventually went into alcohol withdrawal while hospitalized. Those who
tested positive for an elevated blood alcohol level were more likely to develop
a medical complication while hospitalized.

Notably, alcohol tests identified 16 patients who had
previously denied high levels of alcohol intake as high-risk patients for
alcohol use disorders. Alcoholic patients are more likely to underreport their
drinking or view their level of consumption as normal, say the authors.

The study authors suggest that systematic testing for
alcohol in trauma centers makes a great deal of sense, saying "The
relationship between BALs and withdrawal and adverse hospital events indicates
that patients with AUDs develop many problems during hospitalization, such as
longer hospital stays, more complications, more costs. There is no doubt that
BALs should be tested systematically in admitted trauma patients.”

The authors also note that testing for alcohol led to the identification
of nearly 25% of those with an alcohol use disorder that would have been missed
without testing.

Dr. Fleming does note that testing for BALs in trauma
centers has prompted some concern from those who worry that a positive test
could be used to deny insurance coverage for treatment.

Here are 2 facts about alcoholism: It tends to get worse over time (it is progressive) and most people experience a fairly similar progression of symptoms and consequences. Here is a timeline which charts the progressive experiences of alcoholism through the early, middle and late stages. If you have a drinking problem, find out where you fall on the timeline and consider what’s coming in the future. Read Article